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General NPI Number Information
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NPI Number | 1770607384
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Entity Type | Organization
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Legal Business Name | VIRGINIA DARE BEHAVORIAL HEALTH SERVICES INC.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 367 LANE ROAD
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City | STANTONSBURG
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State | NC
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Zip | 27883
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Country | US
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Telephone | 252-238-2622
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Fax | 252-238-6566
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Provider Business Mailing Address
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Address Line | 367 LANE ROAD
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City | STANTONSBURG
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State | NC
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Zip | 27883
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Country | US
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Telephone | 252-238-2622
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Fax | 252-238-6566
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS PHYLLIS MAXINE WARD
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Credential |
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Telephone | 252-238-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | MHL040016
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License Number State | NC
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